Optic Perineuritis and Associated Clinical Imaging Techniques

Optic perineuritis is an uncommon inflammatory disorder primarily targeting the sheath that envelops the intraorbital optic nerve. Clinically it presents with subacute visual impairment, often accompanied by periocular discomfort or pain on eye movement. Distinct from optic neuritis, it tends to involve bilateral eyes and shows sparing of the nerve parenchyma on high-resolution imaging. Underlying causes include systemic autoimmune diseases, infections, idiopathic inflammation and paraneoplastic processes. In the global context, timely recognition of optic perineuritis is vital to preserve visual function and to unveil systemic conditions that may otherwise remain occult. Magnetic resonance imaging (MRI) remains the reference standard, employing contrast-enhanced fat-suppressed T2-weighted sequences to demonstrate perineural enhancement, the so-called ‘tram-track’ and ‘doughnut’ signs. Recent advances have explored diffusion-tensor imaging and optical coherence tomography to quantify microstructural changes and assess axonal integrity. Computed tomography can complement MRI by excluding orbital masses or bony pathology, while ultrasonography may reveal sheath thickening. Collectively, these modalities sharpen diagnostic accuracy, guide immunosuppressive therapy and enable longitudinal monitoring of treatment response.

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Optic Perineuritis and Associated Clinical Imaging Techniques publication trend

The graph below shows the total number of articles in optic perineuritis and associated clinical imaging techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Optic Perineuritis: Inflammation of the meninges surrounding the optic nerve, resulting in sheath thickening and enhancement without primary nerve fibre injury.

Perineural Enhancement: Increased signal intensity on post-contrast MRI around the optic nerve indicating inflammatory involvement of the sheath.

Tram-track Sign: Parallel linear areas of enhancement on axial MRI flanking the optic nerve, characteristic of perineuritis.

Fat-suppressed T2-weighted MRI: MRI sequence that suppresses the high signal of orbital fat to improve visualisation of inflammatory or oedematous changes.

Myelin Oligodendrocyte Glycoprotein (MOG) Antibody: An autoantibody directed against a component of the myelin sheath; its presence can reflect a distinct demyelinating process sometimes manifesting as perineuritis.

References

1. Optic Perineuritis and Its Association With Autoimmune Diseases. Frontiers in Neurology (2021).
2. Recurrent Optic Perineuritis With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Complicated With Granulomatous Polyangiitis. Cureus (2022).
3. Optic Perineuritis Presenting with Transient Monocular Vision Loss (TMVL): Case Report. International Medical Case Reports Journal (2024).